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ViewChange: HIV Prevention - Looking Back & Moving Forward
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ViewChange: HIV Prevention - Looking Back & Moving Forward
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Scaling Up Male Circumcision
Since the first official confirmed cases of HIV 30 years ago, millions have died, particularly in developing nations. But now there's hope in treatment and innovative prevention strategies. Take a journey to find out what's working in HIV prevention -- and providing hope for the future -- in this new half-hour documentary produced by ViewChange in partnership with PSI (Population Services International).
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Segment 1

DEBRA MESSING [Ambassador, Population Services International]
Next up: It’s the pandemic that has touched millions -- AIDS. Thirty years after the first confirmed cases appeared, where are we now? And what’s working in HIV prevention? Find out in this special report from PSI and ViewChange.org.
VOICEOVER
ViewChange is about people making real progress in tackling the world's toughest issues. Can a story change the world? See for yourself in ViewChange: HIV Prevention - Looking Back & Moving Forward.
DEBRA MESSING
I'm Debra Messing, Ambassador for PSI. It’s been 30 years since the Centers for Disease Control confirmed the first cases of HIV in the United States. Since 1981, more than 30 million people around the world have died of AIDS-related causes -- particularly in the developing world, where the disease has devastated entire families, communities and generations. But thanks to the medical advancement of antiretroviral therapy and progress in prevention, saving lives is now possible. Aid groups and governments have been working hard to bring innovative HIV prevention methods and tools to scale -- and it’s working. In Mozambique, one young relationship counselor is getting creative. Working with a local radio show, she is finding ways to make condoms exciting -- and even sexy.
TITLE
Reclaim the Condom
TITLE
Reclaim the Condom, tve, Mozambique
VOICEOVER
Like all countries in southern Africa, Mozambique suffers from HIV/AIDS. Every year, millions of dollars are spent on prevention campaigns, including promoting condoms. But the battle is far from won, and one person thinks she knows why.
SHEILA MANJATE [Sexual Health Counselor, North East Secondary School]
I don't know how many students there are, maybe eight thousand. To pick up condoms? I have the records here. Maybe a hundred per month.
VOICEOVER
At the North East Secondary School in the capital Maputo, 22-year-old Sheila is a trained sexual health counselor. In her office, young people come to her with their intimate problems.
BOY 1
I'm having a problem with my girlfriend.
SHEILA MANJATE
And you did not use a condom?
BOY 1
Often we didn't use it.
SHEILA MANJATE
Because you trusted her?
BOY 1
I risked it because I trusted her, but I mistrust her at the same time.
VOICEOVER
The message is clear -- selling condoms as barriers against HIV can suggest couples don’t trust each other. So Sheila’s convinced it’s easier to sell condoms as contraceptives. Today in her office, she’s tearing down the public health posters. For Sheila, condoms are the main weapons against HIV/AIDS, but they must have the right image. The unbranded "white" condoms are the ones distributed in schools and clinics. Much better, she says, those more sexy, branded ones.
VOICEOVER
Sheila lives at her grandma’s. A churchgoing Christian, she wants to train as a lawyer. She says what some in the big health agencies think privately.
SHEILA MANJATE
The condom is too associated with HIV and so it has become stigmatized in the people's minds.
VOICEOVER
She’s backed by market research, which shows trust in relationships is the main reason for not using condoms. Sheila knows sex and romance sell, so why not use them to promote condoms? She is working on a radio program to try her message on a wider audience. It's for 99FM, a popular national radio station. Today is the big sell.
SHEILA MANJATE
I'm very nervous. I'm in the hands of God.
VOICEOVER
Sheila’s off to see the head of the station. But will he buy her maverick message?
SHEILA MANJATE
Our idea is to make a pilot program.
NELSON CAMAL [Station head, SNYC 99 FM]
Yesterday I attended a Millennium Village ceremony in Chibuto. They had a box of condoms like this one. I didn't want to take any.
SHEILA MANJATE
Exactly.
NELSON CAMAL
But what are we going to say in the program? No to the AIDS condom, or are we going to say AIDS condom, yes?
SHEILA MANJATE
No, our objective is to say yes to the condom.
VOICEOVER
Not only have they given her airtime, 99FM has given Sheila her own team. Their slogan: "For Your Up Moments!" Public health campaigns find it difficult to link condoms with pleasure. But can you really sell condoms better branding them with sex than with illness? Early morning, and time to take the show on the road. Today to Xinavane, 100 kilometers north of Maputo. For her program, Sheila wants people to talk openly about their sex lives. She hopes their stories will reveal why they should use condoms. She's taking the message to the local school, to see how it plays.
SHEILA MANJATE
Our mothers fell pregnant at the age of 14, 15, 16, 17; they lived their sexuality at the moment they felt the time had come. I want you to tell me: What do you do to live your sexuality, without having the same problems our mothers had? What did you say?
MALE STUDENT 1
I use the condom.
SHEILA MANJATE
You used the condom. Thank you. Ping pong, another one. What do you do?
FEMALE STUDENT 1
Condom.
SHEILA MANJATE
Condom. Who else?
FEMALE STUDENT 2
Fidelity.
SHEILA MANJATE
Fidelity. Who else?
FEMALE STUDENT 3
Condom.
SHEILA MANJATE
Condom. Who else?
MALE STUDENT 2
Fidelity.
SHEILA MANJATE
Fidelity. Who else?
FEMALE STUDENT 4
Condom.
SHEILA MANJATE
Condom. Who else?
FEMALE STUDENT 5
Be faithful to my boyfriend.
SHEILA MANJATE
Be faithful to your boyfriend? I have to be faithful to my boyfriend, but I also have to be faithful to the condom, because the day my boyfriend drops me, the condom will stay with me.
TITLE
Sheila continues to encourage a change in the perception of condoms with young people in Mozambique.

Segment 2

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ViewChange
DEBRA MESSING
In India, where millions are living with HIV, reaching at-risk populations through peer education is crucial. And as this story shows, the most powerful messengers for HIV awareness come from unlikely places.
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ViewChange
TITLE
Peer education is a powerful tool in the prevention of HIV, but also in creating awareness and supporting those receiving care.
MADAN KOIRALA
First I'm going to play soccer. I'm going to shoot two goals. Obviously we will win! I have many qualities. I am handsome. I am a role model for the people watching.
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Madan
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Element: Madan, Element, India
MADAN KOIRALA
I was a drug user before. My ambition was to use drugs, and die. I am from Nepal. I came to Delhi just to use drugs. One of my friends sent me a message saying the drugs were good in India. I said, "Okay, let's go." I spent all my money. I was totally broke. I thought, "I'm going to die, I can't live any longer." Suddenly, I changed my mind.
TITLE
New Delhi, India
MADAN KOIRALA
I got a message that there is a rehab center where we can get treatment, and I said, "Okay," because I am a drug user and I needed treatment. I changed my lifestyle, and in the meantime I met my girlfriend, who is really cute! Life is not only for using drugs, eating food, and sleeping.
TITLE
Millennium Development Goal #6: Stop the spread of HIV/AIDS and other major diseases
MADAN KOIRALA
Now I am employed at Michael's Care Home, and I have to take care of HIV positive people who need treatment and help. Whether they're HIV positive or not, I always see them as a human being and in need of care and treatment. In India, people think that if you're HIV positive, you've got AIDS and you're going to die soon. Actually they're quite different. "AIDS" means you're sick, but being "HIV positive" just means you have the virus. Still people are very scared. They think that if someone's infected with HIV, we'll get infected too. No, we can't get it through the air, we can't get it from mosquito bites, we can't get it from kissing, and yet still there's all this discrimination. They're made jobless, homeless, and they're kicked out of society. Let them live! There are lots of examples of people who are very sick, and then they take the ARV medicine and live normally. This is anti-retroviral medicine, "ARV" medicine.
MAN 1
It reduces the multiplication of the virus.
MADAN KOIRALA
In India, only around twelve thousand people are getting this medicine. But there are over five million people infected with HIV. They should fight for them to get ARV medicine too. We need ARV medicine to be available free to everyone who needs it. Finish! There's something inside me that I can expose to the whole world. I am Madan Koirala, and I am HIV positive.
TITLE
HIV+
MADAN KOIRALA
If you look at me, can you make it out that I'm HIV positive? No, no one can tell.
MADAN KOIRALA
The message for the new generation is: positive living, positive thinking. No discrimination and stigma. There is hope. Now clap your hands!

Segment 3

DEBRA MESSING
Operating in 67 countries around the world, PSI is one global health organization at the forefront of HIV prevention. PSI believes that health services and products are most effective when they are accompanied by robust communications, which ensure that people are widely accepting and using prevention methods. And they’ve found that some of the best communicators about safer sex and HIV prevention are not necessarily the typical experts. For example, hairdressers in Zimbabwe are chipping in with their own straight-talk to patrons -- and have helped Zimbabwe cut its HIV infection rate by half. Last year, I traveled with PSI to visit one special salon in Zimbabwe where women are sharing life-saving information with one another -- truly unforgettable.
TITLE
ViewChange
TITLE
Braids Not AIDS, DFID, Zimbabwe
VOICEOVER
As the economy in Zimbabwe begins to recover after years of chronic mismanagement and hyperinflation, there are also encouraging signs of a decrease in HIV prevalence. In a country where over one million children have been orphaned by AIDS, now an innovative HIV prevention program is showing remarkable success by using hairdressers to teach their female customers the facts about HIV and AIDS. But in a country with a collapsed medical infrastructure, the burden of HIV and AIDS is massive. There are around 60,000 deaths from AIDS each year, and an estimated 1,200 new infections each week. Experts in Zimbabwe say prevention through behavior change is the key to managing the spread of the disease.
KUMBIRAI CHATORA [PSI Zimbabwe Deputy Country Director]
When we talk about behavior change, the key word there is changing. Changing from what you used to do to a new behavior. We want people to adopt safer sexual behaviors. It could be condom use, it could be knowing your status, it could be having fewer partners. All that for us is behavior change, anything that you do to protect yourself from HIV infection.
VOICEOVER
But in a male-dominated society like Zimbabwe, reaching women with the correct information and empowering them to make decisions can be difficult.
WENDY TAKUNDWA-BANDA [DFID Zimbabwe HIV Program Manager]
Generally women are the more vulnerable sex, and when it comes to making decisions related to sexual health, men are the dominant character. So women don't have much say.
VOICEOVER
As a result, 60 percent of all people living with HIV in Zimbabwe are women. Dorothy Nyamukapa is a hairdresser in Kuwadzana, a low-income high-density suburb of the capitol Harare. Dorothy is one of 1,500 hairdressers that have been trained as an HIV peer educator in a program run by Population Services International and funded by the UK's Department for International Development.
DOROTHY NYAMUKAPA
Because I am a woman it is very simple for me to approach them. I ask her which family planning she uses. When she told me, I started to introduce them to "Care."
VOICEOVER
In this way, hairdressers like Dorothy have sold over three million female condoms in the last six years, preventing thousands of new HIV infections. Barbra Nyandika, a regular at the salon, began using the female condom with her husband Obit two years ago.
BARBRA NYANDIKA
I went to my husband and told him about female condoms. Then he said I have to bring it so that he can see it. Then I have to introduce it to him and he said that it is very nice, that we have to continue using it.
VOICEOVER
This initiative is spreading across Zimbabwe. Sylvester Nzaras runs a barbershop from his backyard in the commuter town of Chitungwiza, south of Harare. Here, men are also being exposed to the prevention message and the benefits of condom use. While huge challenges remain in Zimbabwe, the success of programs like this has contributed to a significant decline in HIV prevalence, a drop from over 24 percent to less than 14 percent over the last six years.

Segment 4

TITLE
ViewChange
DEBRA MESSING
But how will we really achieve large-scale change? One of the ways is by promoting HIV prevention methods that are easily affordable, highly effective and are able to show results now. Methods like voluntary male circumcision, which can reduce heterosexual HIV transmission by 60 percent. But first, grown men must be convinced to overcome their fears, as we see in this story.
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ViewChange
TITLE
PSI Botswana's Male Circumcision Campaign - TV Spot
TITLE
Scaling Up Male Circumcision, PSI, Sub-Saharan Africa
VOICEOVER
All right team: remember that we have to work at winning this match as a team. Circumcision cannot win this match alone. He needs the help of all of the defenders to keep HIV from scoring.
TITLE
Men in Sub-Saharan Africa are choosing male circumcision (MC), a cost-effective method that reduces the risk of HIV infection in men by 60 percent. Beginning in 2007, PSI launched an unprecedented MC campaign supporting service delivery, communications, and advocacy efforts in Botswana, Kenya, South Africa, Swaziland, Zambia, and Zimbabwe. These are the stories of men and families being impacted by male circumcision.
FUNGAI CHIBAYA [MC Client, Zimbabwe]
My name is Fungai. Near where I stay, there is a very big billboard encouraging male circumcision, so I just decided one day that I should do it. I'm shaking a little bit, like goosebumps. I think the procedure is going to go well.
TITLE
PSI provides pre- and post-procedure counseling in countries where male circumcision is offered.
FUNGAI CHIBAYA
I've learned a lot about male circumcision. They say it has a 60 percent chance of HIV reduction.
TAKAVINGWA KOMBONI [MC Client, Zimbabwe]
My name is Takavingwa Komboni. My wife encouraged me to come to MC because she actually thought it would be good for me to be circumcised. Some of my friends said, "You can go at your own risk." I'm curious to know what's going to happen after I'm circumcised.
SYMPATHY MPOFU [Clinical MC Nurse, Swaziland]
The local anesthesia is given to assist him in reducing pain during the surgical procedure. The procedure starts with the doctor cutting and removing the foreskin. Afterwards we dress the patient with gauze. Then the patient is escorted to the recovery room to recover for 30 minutes.
TAKAVINGWA KOMBONI
As you can see, I am now coming out of the theater room. The circumcision is over, and I feel like a man. It has been very good, and it is not as painful as I thought.
FUNGAI CHIBAYA
The whole procedure was just fine.
TITLE
Changing perceptions, one person at a time.
JABULANI NCUBE [MC Client, Zimbabwe]
One of the best benefits is the reduction of the HIV/AIDS transmission rate. That gave me the zeal to go for it. I felt it would be the best opportunity for me to prevent myself, and the person that I love, from contracting such infections.
STEVEN CHIKOMBERO [MC Client, Zimbabwe]
I've since introduced some of my team members to be circumcised. Everyone now knows that I'm proud to be circumcised.
TITLE
Women are important partners in this process.
KUDZAISHE CHIFAMBA [MC Client, Zimbabwe]; It opens up dialogue within the relationship, which is not common in our environment. >> MOLEBOGENG MADISHA [South Africa]
So this is both of our decision, and I decided to accompany him as a support system. I also heard about the importance of male circumcision.
TITLE
Communication is key to male circumcision scale up.
JABULANI NCUBE
What I learned is that people are not well educated. They have a belief that it's cultural.
KUDZAISHE CHIFAMBA
Dialogue needs to spread further than just young couples.
TITLE
By bringing services to scale within the next 10 to 20 years, male circumcision could significantly reduce the number of new HIV infections.
JABULANI NCUBE
It is the right channel to reduce the HIV/AIDS pandemic in our nation.
TITLE
Effective communication. High quality service delivery. Thirty-eight million by 2015: scale up male circumcision now, impact the future of HIV.
STEVEN CHIKOMBERO
A lot of things have changed in my life. Besides the confidence that I have, I also feel much more secure.

Segment 5

TITLE
ViewChange
DEBRA MESSING
Targeting behavior is also crucial in HIV prevention. In Kenya, people are talking about Mpango wa Kando -- roughly translated into "having a long-term relationship on the side." It’s an all-too-common arrangement that also happens to be one of the riskiest behaviors for HIV transmission. But the government of Kenya, together with USAID and other groups, is using mass media to change this behavior and turn the tide of HIV transmission.
TITLE
ViewChange
JIMMI GATHU ["Mpango wa Kando" Spokesperson]
Are you married? So you're sitting with your husband, right? Do you know if he has a girlfriend?
TITLE
Roughly 33 million people are living with HIV/AIDS, twenty million plus in Sub-Saharan Africa. In Kenya, one behavior is playing a major role in transmission: concurrent sexual partnerships.
JIMMI GATHU
There is only one way to stop HIV from destroying your marriage. It's simple. Guys, leave your side arrangement. Avoid HIV.
TITLE
HIV and Concurrent Relationships, PSI, Kenya
TITLE
PSI and the government of Kenya address this issue head-on through a groundbreaking communications campaign: "Mpango wa Kando."
DR. NICHOLAS MURAGURI [Director, National AIDS/STD Control Program]
Forty-four percent of new HIV infections are attributed to people who are either married or are in partnerships. These people in partnerships also have other partners, who also have other partners, who are not using condoms. And therefore, the chance that in that network somebody has HIV -- it spreads like bushfire to the rest of the families.
TITLE
Your spare wheel could have a spare wheel who has a spare wheel who has a spare wheel who has HIV. HIV now spreads fastest in marriages. Here's the reason why.
JIMMI GATHU
I must admit that one of the things that surprised me was the aspect of also women playing a part in it.
DR. NICHOLAS MURAGURI
We got a strong voice, people said, "No, no, no, you are condemning men only. Women also do that." So we made some TV spots for women as well.
JIMMI GATHU
Mama, how are you? So you are in an outing of your woman self help group? So that man standing next to you is definitely not your husband, right? Do you know research shows nearly half of all new HIV infections are happening in marriages like yours?
ERICK WAGA [Research Consultant for PSI]
Concurrent partnership really is a great factor in the spread of HIV because you find that these people, when they have these partners, trust comes in. So you find that these partners stop using condoms throughout all the partners.
LUCY MAIKWEKI [HIV Deputy Director, PSI]
PSI Kenya started to take on the campaign boldly, because primarily there are very few organizations that do national level mass media communications.
TITLE
Giving Kenya something to talk about.
TONY NJUGUNA [Creative Director, SCANAD]
For this particular brief it became quite an interesting angle for social marketing. We’ve got a social responsibility to improve the lives of the people that we are trying to talk to.
TITLE
Social marketing (so shel mar kit ing) n. 1. The application of marketing concepts and techniques to influence behavior among a target audience in order to benefit themselves and society.
LUCY MAIKWEKI
We pre-tested various concepts, various taglines, various names and eventually we came up with Mpango wa Kando, which was what people felt describes this loving, long-term side relationship.
JIMMI GATHU
Somebody needed to say something. And so we did. Shock transmits, then, to how important this campaign is.
TONY NJUGUNA It makes sense, it's logical, and I think that's what really made the campaign work
that it's real; it's a social message.
TITLE
Sparking conversations in the community.
DR. NICHOLAS MURAGURI
The Mpango wa Kando campaign is obviously achieving its goal. Part of the goal was to start a debate, so you'll hear people discuss it in pubs, in family outings, in the church. These things were never discussed.
TOM NGARAGARI [Behavior Change Communication Coordinator]
They identify with the campaign, and then now the discussion starts. The good thing is that they are coming together and talking about it and finding solutions to it.
TITLE
Moving forward...
LUCY MAIKWEKI
Looking at what will motivate people now to move from awareness to actual behavior change.
TITLE
...to prevent HIV/AIDS.
DR. NICHOLAS MURAGURI
If you look around, all families, all Kenyans, don't want HIV. You cannot talk about the issue of HIV and not talk about concurrent partnerships.
LUCY MAIKWEKI
For me, success in the long term for this campaign would be lower HIV prevalence amongst people in married, co-habiting relationships.
DR. NICHOLAS MURAGURI
It's something that cannot be done overnight, it's something that we need to work on until it becomes a social norm change that discourages people from having concurrent multiple partnerships.
TITLE
ViewChange
DEBRA MESSING
Thanks to prevention and treatment, the global rate of new HIV infections has dropped by 25 percent between 2001 and 2009. Around the world, we’re learning lessons from innovators in every sector. We’re learning to adopt messages that equate change with something everyone wants -- a happier life. We’re learning to invest in local talent, because they know how to reach their neighbors and what motivates them to change. And on the soccer field -- or at the hair salon -- we learn that reinforcing the right messages about HIV/AIDS is making a difference.
VOICEOVER
Want to learn more about HIV treatment, prevention, or anything else you saw here? Head over to ViewChange.org/TV, where you can watch, read, and get involved in projects that are making a real difference. Watch the films you just saw, and over 350 more from around the world, at ViewChange.org/TV.
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[End Credits]
TITLE
A co-production of Population Services International and Link TV. To read about PSI's HIV prevention programs around the world, visit www.psi.org.